Neurology
Expert perspectives on neurological conditions, stroke management, movement disorders, and neuromuscular disease.
Recent Discussions
What schedule and type of antiemetics do you provide for patients receiving PCV for co-deleted oligodendrogliomas?
I give 16 mg ondansetron and 20mg dexamethasone one hour prior to CCNU/lomustine on day 1 and then 8mg dex on days 2 and 3. I do always prescribe ondansetron q8h as needed and give them compazine to have as well, as needed, q6h. I've honestly had most patients not need anything further, but if they ...
Would you consider spinal cord biopsy for an intramedullary cord lesion with disabling neurological deficits and no diagnosis despite a comprehensive workup?
I would probably do a literary research, and then ask my neurosurgical colleagues if they have had any experience doing that. If they are unsure, I would use the web to track down centers that have a high workload experience of doing a biopsy and direct the patient to be seen at that center provided...
What is the dose conversion formula from botulinum toxin type B (Myobloc®) to incobotulinum toxin type A (Xeomin®) or onabotulinum toxin type A (Botox®)?
There is not a set formula for converting from one formulation to another. In fact, each manufacturer warns against it. One possible guideline: Xeomin:Botox is 1:1. Dysport:Botox is 2.5-4:1 and Myobloc:Botox is 40-50:1. If I need to switch serotype, I would err on selecting a lower dose to start to ...
What are your top takeaways from AAN 2022?
My attendance was somewhat limited due to having a speaking role, but select takeaways are as follows: 1. Neurologists need to be creative and strategic in managing neurologic conditions in athletes. Particularly this is true in terms of medication selection and mitigating side effects that may im...
In what patients would you consider adjunctive IVIG for Sjogren's-related neuropathy?
Would consider IVIG in Sjogren's with disabling neuropathy not responding to other treatments (steroids/DMARDs, mycophenolate), in sensory ataxic neuronopathy/dorsal root ganglionitis, and immune-mediated (CIDP).Co-manage with neuro-immunologist, if an option.Literature is a small case series and ca...
How do you taper off Clonazepam in women with epilepsy who are family planning?
Is she only on clonazepam and how much dose? Is she on additional AEDs and how many? Has she failed other AED and what are the other options I can add simultaneously while tapering off clonazepam? What type of epilepsy patient has? These are some of the considerations to keep in mind before switchi...
How do you approach treating patients with trigeminal trophic syndrome?
Very difficult to treat but I have found some success with compounded topical gabapentin (I use gabapentin, amitriptyline, lidocaine from skinmedicinals) +/- PO neuromodulator drugs (gabapentin, TCA) followed by reconstructive surgery with a flap of innervated skin as a last-line. For an itching ...
Do you discourage patients from skydiving/roller coasters with a Chiari malformation?
No, I don't.
At what point do you recommend muscle biopsy in the workup for myositis?
Muscle biopsy is generally recommended and useful in most cases of suspected inflammatory/immune myopathy; accurate pathologic diagnosis is imperative for prognostication, identification of comorbid conditions (e.g., cancer, interstitial lung disease, arthritis, etc.), and treatment decisions. Histo...
What workup do you recommend for patients with low back pain and imaging concerning for spina bifida occulta?
In cases of suspected spina bifida occulta, imaging of the entire spine and Neurosurgery referral are usually recommended. MRI is generally considered the imaging modality of choice, which can also detect other coexisting abnormalities such as tethered cord, while CT can be helpful in better imaging...